Question

A 27-year-old hemodynamically stable woman has early pregnancy bleeding. TVUS shows an adnexal mass 2.8 cm and no intrauterine pregnancy; fetal cardiac activity is absent. Serum β‑hCG is 3,200 mIU/mL, and she has no contraindications to methotrexate. Best management?

Accepted Answer

Two-dose methotrexate without measurement

Answer

Urgent laparoscopic salpingectomy

Answer

Expectant management until β‑hCG declines spontaneously

Answer

Single-dose methotrexate 50 mg/m2 IM with close follow-up

Answer

Administer misoprostol and observe

Practice question

A 27-year-old hemodynamically stable woman has early pregnancy bleeding. TVUS shows an adnexal mass 2.8 cm and no intrauterine pregnancy; fetal cardiac activity is absent. Serum β‑hCG is 3,200 mIU/mL, and she has no contraindications to methotrexate. Best management?